Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: A systematic review of survival, mortality and morbidity

Abstract

Introduction Gastric cancer with peritoneal carcinomatosis (PC) has an extremely poor prognosis with median survival estimated at four-months with best supportive care, and 7-10 months with aggressive chemotherapy. Cytoreductive surgery combined with heated intra-peritoneal chemotherapy (HIPEC) has been shown to improve survival in colorectal cancer with PC compared to systemic chemotherapy. The efficacy of cytoreductive surgery combined with HIPEC in gastric cancer remains unproven. Our objective is to systematically review the literature regarding the effectiveness of cytoreductive surgery combined with HIPEC in patients with gastric cancer who also have PC. Methods A comprehensive search of electronic databases was completed from 2000-2010. Unpublished and non-English-language results were excluded. All studies involving cytoreductive surgery combined with HIPEC in adults with gastric cancer with PC were included. Two authors identified potentially relevant articles and assessed the studies for inclusion, and extracted data. Results An initial screen identified 144 titles of which 36 studies met the inclusion criteria. Following full manuscript assessment, 10 articles were included. 441 patients with gastric cancer and PC were extracted with a median follow-up of 48 months. Overall median survival was 7.9 months (range: 6.1-9.2 months) and improved to 15 months (range: 9.5-43.4 months) for patients with completeness of cytoreduction scores of 0/1. The median 30-day mortality rate was 4.8% (range: 0-14.3%) with combined morbidity of 21.5%. Conclusions This systematic review demonstrates that combined cytoreductive surgery and HIPEC may improve survival in selected patients with gastric cancer with PC when a complete cytoreduction is achieved, albeit with significant risk of mortality and morbidity.